Post-LASIK corneal epithelial irregularities October consultation #1

Area of Science:

• Ophthalmology
• Refractive Surgery
• Corneal Disease

Background:

• A 55-year-old male with a history of bilateral laser-assisted in situ keratomileusis (LASIK) and enhancement presented with progressive visual blurring and fluctuation.
• The patient sought to discontinue contact lens and spectacle wear but experienced declining uncorrected distance visual acuity (UDVA).

Observation:

• Clinical examination revealed diffuse subepithelial fibrosis and irregular corneal topography, including significant inferior steepening.
• Anterior segment ocular coherence tomography (OCT) confirmed subepithelial hyperreflective density, indicative of fibrotic changes.
• Previous records showed stable vision and regular corneal topography, suggesting a recent onset of pathology.

Findings:

• The patient was diagnosed with significant corneal subepithelial fibrosis, likely secondary to prior LASIK.
• Keratometry revealed marked irregularity and steepening, particularly in the inferior cornea, up to 52.0 D.
• Low residual stromal bed precluded further refractive surgery, and fluorescein pooling was noted.

Implications:

• Subepithelial fibrosis following LASIK can lead to progressive vision loss and irregular astigmatism.
• Diagnosis requires advanced imaging like OCT and careful review of historical corneal topography.
• Management focuses on visual rehabilitation and ruling out other causes of corneal irregularity, as refractive surgery is not an option.